I’ve spent my career in the health care field, most recognizably as Institutional Investor Magazine's #1 ranked health care analyst for six years in a row and as a portfolio manager for a leading hedge fund. I have advised some of the world’s most prestigious institutional investors and counseled some of the largest and fastest growing health care companies. Before recently starting my own firm, I was the US pharmaceuticals equity research analyst for CLSA, Asia's leading independent investment bank, and previously worked for a number of other investment banks covering healthcare. The Wall Street Journal and Institutional Investor magazine have several times named me Top Stock Picker, Top Industry Knowledge, and Best on the Street. I have appeared in numerous media including Forbes, The Wall Street Journal, and CNBC. My focus is assessing global healthcare trends and new technologies, and looking for attractive healthcare investment opportunities. Follow me on Twitter @davidmaris

ObamaCare Unpopular, But Romney Still Needs To Watch His Step

The Affordable Care Act – widely known as ObamaCare – remains unpopular, but the country is evenly split on the measure. Instead of looking at who supports ObamaCare by political party affiliation as many other surveys have done, my firm decided to look at the underlying demographics of who supports and who opposes the healthcare law. Subtle demographic differences, combined with the near even split of opinion, will shape how Mitt Romney attacks Obama’s most significant legislative program passed during his term, and how President Obama defends it.

According to a national survey being released today and conducted April 6 – 13, 2012, 49.8% of Americans say that if they had the chance, they would vote against ObamaCare, while 50.2% said they would vote for it. In a separate question, 56% of Americans surveyed said that the government should not provide healthcare for everyone. My firm, Phalanx Investment Partners, commissioned the survey.

These results are consistent with many other polls that have found no broad support for the measure. Who then are the people that support ObamaCare and who are against it? As we look at this more closely, we can see why both Romney and Obama need to tread carefully.

However, the results turned more negative when we asked a similar, but slightly different question; 56% of those surveyed indicated that the government should not provide free healthcare to everyone even if it resulted in higher taxes.

I suspect that the connection of the phrases “government provide free” and “higher taxes” strikes a chord with some respondents concerning government intervention and the prospects of higher taxes. The plan might not be popular, but perhaps the more it is associated with the prospects of higher taxes and government intervention, the more it will resonate with voters. It might not just be enough to say, “Undo the plan.”

The Age Effect – Middle Age Voters More Clearly Against ObamaCare

According to our data, the measure has the support of younger voters with a 55% of 18 – 24 year olds and 62% of 25 – 34 year olds saying they would vote for it. In every other older demographic, ObamaCare fails to get a majority of support. In fact, of 45 – 54 year olds, and 55 – 64 year olds, only 42% would vote for it.

According to the Pew Research Center, these older Americans are key age demographics as they tend to vote more often than other age demographics, and they both have a large number of intermittent voters – voters that come out when they feel compelled on an issue or candidate.

The age effect and the negativity toward government-run healthcare are even more apparent in our second question – whether the government should provide healthcare to everyone. The only age demographic, which says “yes, the government should provide healthcare to everyone” are 25 – 34 year olds and there is it a narrow 51% minority.

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Thanks for reading the article, but I have a couple reactions to your comment. First, I am not sure that “every other successful country has government healthcare” is valid. The US has been immensely successful without it, so why is that not the reason to NOT have it. Second, the other countries have not been successful because of government healthcare, in my opinion. The UK is no more successful because of it – nor is Canada – etc… I would argue countries such as Greece, Spain, and even Japan are hindered by it. Third, I think that if the fault for lack of support is on those that are uninformed, then whose job is it to inform the general population? I think the closed door sessions, the rushed partisan vote, and the roughshod policy is why we have a division of opinion.

You certainly missed the point, other successful countries did not succeed because of health care. In there success they realized that what contributed to their success was a healthy citizenship. Recognizing this and having some connection to Christianity, they decided that it was desirable to have a healthy populace to continue and extend their success.

By contrast, the United States of America, with GREED and AVERICE has a small minority of very wealthy who’s motto is “I got mine to hell with you”. This unfortunately is what is destroying our country from within, instead of furthering DEMOCRACY, steering a course to AUTOCRACY and ANARCHY!

I think the definition of “successful country” is kind of broad. When it comes to healthcare, I wonder why we do not see more fact-based analyses and articles. It bugged me that we were paying twice as a % of GDP for healthcare than other “developed nations” twenty years ago. When that percent was “only” 11%. Now it is over 18%?

And forgive me but besides facts, I like well constructed arguments instead of who shouts (polls) the louder. Comparing apples to apples instead of opinions. Do we pay twice our wealth (%GDP) for poorer results? Most respected analyses say yes – we have far worse infant mortality, shorter life expectancy and many other metrics (no, not Botox access!) that are apparently important and measurable, than those other countries. So yes, Greece is bankrupt, but Germany and the northern Euro nations have a far, far better deal than the wacky tangle of payers, providers and whatever here.

With or without Obamacare, we’ll still have to deal with the hidden costs of our healthcare system and insurance. Consider:

Most of us drive our vehicles very carefully, even though we have insurance to cover accidents.

But suppose you had no insurance. (I periodically went without it when I was a young adult and earning a pittance.) Think how much more carefully you’d drive! And how much more slowly. Yes, you would. And you’d likely drive less. (And maybe walk more and become healthier for it.)

For many people, I suspect, the more auto insurance they have, the more they tend to drive and to drive faster and less guardedly. (For proof of that, keep imagining how you’d drive without insurance.) That means more accidents in which people are killed and injured. Although insurance is a wonderful thing — preventing, for example, countless bankruptcies and bestowing peace of mind — it might have the unintended consequence of causing more accidents and more deaths and injuries than if no one had insurance.

Now consider:

In a report on how to fight pandemics, the March 2012 Discover magazine says the secret to fighting them is “knowing their real cause: disease factories built by people. Ironically, hospitals turn out to be highly efficient disease factories. They allow the proliferation and spread of dangerous germs among patients, and the evolution of those germs to extreme levels of virulence.”

In that same vein, the Journal of the American Medical Association stated 12 years ago:

“America’s healthcare system is the third leading cause of death in the U.S., causing between 230,000 and 284,000 fatalities per year, behind only heart disease and cancer.”

The report didn’t say the third leading cause of death is poor health. It said the healthcare system itself. In other words, our country’s third leading cause of death is the army of good-intentioned doctors, nurses, and others whose ultimate duty is to help us avoid death.

JAMA provides a breakdown of the deaths caused by healthcare:

- 12,000 deaths per year due to unnecessary surgery - 7,000 deaths per year due to medication errors in hospitals - 20,000 deaths per year due to other errors in hospitals - 80,000 deaths per year due to infections in hospitals - 106,000 deaths per year due to negative effects of drugs

Then add the nearly 200,000 patients that may be killed each year by blood clots following surgery or illness, the leading cause of preventable hospital deaths in the U.S., according to David Goldhill, author of “How American Healthcare Killed My Father,” citing a report in The Wall Street Journal. (Watch Goldhill’s video at http://www.cato.org/event.php?eventid=6597)

It makes one want to ask an absurd question: “Why don’t we drop our health insurance and stay away from doctors?”

If no one had health insurance, lots of things could happen, good and bad. Here’s a quirky thing I believe is possible:

In 2008, shortly after the economic collapse, I was watching a CNN reporter interview a woman on the street. She had just lost her job. The reporter asked how she was coping.

“Along with my job, I lost my health insurance,” she said [I paraphrase]. “Now I have to really be careful to watch what I eat, lose weight, exercise, and take better care of myself.” I got the impression that while she had health insurance, she tended to be a bit reckless with her health, figuring she was covered if she got sick.

Some people, maybe many, are like that, due to what is called the “moral hazard” (see http://www.slate.com/articles/business/the_dismal_science/2011/07/does_health_coverage_make_people_healthier.html, which says, “Insurance is also the source of what economists call ‘moral hazard,’ where those who are protected against the consequences of their actions take greater risks than they otherwise would.”)

Without health insurance, CNN’s interviewed woman became like the driver without car insurance.

Enter President Obama’s Affordable Healthcare Act (AHA), whose aim is to get everyone insured and require everyone to pay a premium.

A lot of young adults currently elect to have no health insurance (as I did years ago) because of its cost, or because they want to save money while they’re young and healthy. Once forced to buy insurance under AHA, many can be counted on to frequently see a doctor for minor things simply “to get my money’s worth.”

How many more people, BECAUSE they have insurance, will pay less attention to diet and exercise like CNN’s woman on the street, and develop medical problems (such as diabetes) that require visits to the doctor that they would not have had to make while uninsured and cautious?

AHA will bring an estimated 32 million more people, mostly young adults, into the healthcare system and countless others into it more often. It’s obviously supposed to do that, because Mr. Obama wants to spread the health around.

Moreover, every day for the next 18 years, 10,000 Baby Boomers will reach age 65 and become eligible for Medicare; many of them will seek healthcare services before losing their employer insurance, and many others who’d had no insurance and had put off healthcare will do so no longer.

Finally, we have a obesity epidemic that is growing and threatening to overwhelm our health care system. The main threat is the costly diabetes that is often obesity’s side effect.

The upshot is that millions more will interact with the healthcare providers who are, according to JAMA, our nation’s third leading cause of death.

These providers, unless there is a huge increase in their already insufficient number, will be stressed by the increased demand for services. Their error rate is likely to rise.

Could our healthcare system then become the second leading cause of death? Or even, in the greatest of ironies, the first?

Very clever comment and it gets to an important fact -t he more you isolate people from the impact of their decisions and situation, the less they do to change it. If your healthcare is paid for someone else, then go to town with diagnostic tests etc… It is like how people at a free buffet tend to gorge themselves. Sadly, the same is true with doctor costs. If you never pay for anything, overusing and accepting whatever price is normal. It is the idea of co-pay’s in the US – you pay a co-pay to make sure you feel some economic impact. Too few people know what their hospital bill, their doctor bill, or their prescription bill really is. I think many (probably most) Americans do not think people should have to face the decision between food for their family and a prescription or a doctor visit. But they don’t want to subsidize their care if the saved money saved is going to buy an iPhone or cigarettes.

Responses to polls are based on the way the questions are asked, as I’m sure you know. “…even if it means higher taxes” is an automatic button pusher. Some people don’t realize that taxes cover a broad area. Why should Social Security tax be cut off at $110,000 per year? The least able to pay are the ones who pay all year while the higher earners can conceivably pay of their tax in a few weeks or months. Medicare tax? Similar problem. And an easy problem to solve. I know that Forbes favors the well to do, but maybe you ought to give a nod to the Americans who are doing the best we can.

I called out that phrase (“even if it means higher taxes”) as a possible reason for the higher negative response rate and is why I included data from both questions – not just the more negative one. But note, that it is important for people to make a decision based on all possible outcomes and the prospect that a sprawling healthcare plan might cost more than was originally anticipated and as such, might result in higher taxes, is not implausible. As an independent contributor, I don’t speak for Forbes, but I don’t think I or Forbes favor the well to do as you state. As for giving a nod to people doing the best they can, I totally understand. I never stated that the healthcare system was perfect before ObamaCare, and in fact I go out of my way to explain how divided the country is.

I’m sure most people would agree that health care issues need to be addressed, but the reference to the level of fraud and mismanagement is a complaint straight out of the Karl Rove plan book (Contract with America, Legislative Proposal #4.) Karl Rove has done more than his share to contribute to the decline of America and the middle class, and the upsurge of corporate power and divisiveness. Obamacare is already starting to work and anyone who really cares to be informed can go to whitehouse.gov and search for Obamacare (yes, it does show up under that title.)

Fraud in healthcare is is a fair complaint, whether it comes from Karl Rove or Obama – both sides agree that Medicare and Medicaid fraud run into the tens of billions, and fixing that that should be a high priority. I am not sure when you say “ObamaCare is already starting to work” if that is true, and the bigger question is at what cost.

Obamacare has already: –given a new tax credit to small businesses –insured 2.5 million young adults by allowing them to stay on their parents insurance until age 26 –helped senior with the cost of meds –stopped the insurance practice of denying children benefits for pre- existing conditions and lifting the lifetime limits on their care –http://www.whitehouse.gov/healthreform/myths-and-facts